Chewing and Swallowing Problems From Alzheimer’s

WebMD Medical Reference in Collaboration with the Cecil G. Sheps Center at the University of North Carolina at Chapel HillLogo for UNC Chapel Hill, Cecil G. Sheps Center
Medically Reviewed by Christopher Melinosky, MD on November 27, 2022
4 min read

As we get older, our mouths get drier and our sense of taste and smell can change. Many people also have problems with their teeth as they age. All these things can make it harder to eat and drink.

These issues also can be part of Alzheimer’s disease -- nearly half the people with the disease who are in a nursing home have a problem chewing or swallowing. Over time, they may lose weight or not drink enough water and get dehydrated.

Get medical help for your loved one right away if:

  • They pass out.
  • Aren’t breathing normally.
  • They have serious problems breathing or shortness of breath.
  • They have a fever above 101 F.
  • They have shaking chills.
  • Their breathing is noisy or sounds wet while they eat or right afterward.
  • Their vital signs (pulse, temperature, or blood pressure) aren’t normal, especially if they’re breathing very fast.

Call their doctor if they:

  • Have a sudden, serious cough or a change in their voice (like hoarseness)
  • Have pain when they swallow
  • Spit out food or pieces of food, or won’t eat certain foods or drinks
  • Cough or drool when they eat
  • Hold food in their cheek, under their tongue, or in the roof of their mouth
  • Say food "gets stuck" or "goes down the wrong way." If food or drink goes into their lungs instead of their stomach, that can lead to a serious condition called aspiration pneumonia.
  • Clear their throat often or have a sore throat
  • Are sleepy at meals
  • Take longer than 30 minutes to eat or leave meals uneaten
  • Have teary eyes or a runny nose when they swallow or right afterward
  • Have food or liquids come out their nose when they try to swallow

You should also call their doctor if they don’t drink enough liquid to meet their needs. Women over 70 typically need a little less than 3 quarts of liquid a day, including what they get in foods. Men over 70 need almost 4 quarts.

If they have a fever, diarrhea, vomiting, or sweat a lot, those are signs that they need more. Signs of dehydration include:

  • Dry mouth, nose, or eyes
  • Peeing very little, or not peeing for 8 or more hours
  • A dry tongue, especially if it’s so dry it has grooves or furrows in it
  • Sunken eyes
  • A heart rate faster than 100 beats per minute
  • Being less alert or more confused than usual
  • Serious weakness
  • Dark yellow urine
  • A hard time speaking

Problems with chewing and swallowing can happen for several reasons:

  • They don’t like the food offered.
  • They’re in pain.
  • They eat very slowly. As Alzheimer’s disease goes on, your loved one may take longer and longer to eat.
  • They forget to swallow. It’s common for people who’ve had the disease for a long time to keep food in their mouth and not swallow it.
  • They have trouble using the muscles that let them swallow. This can make them cough and choke because food or drink has gone into their lungs.

No single solution works well for everyone, so it’s important that your loved one see their doctor. But you can do a few things to help make them comfortable and feel safe when they eat:

  • Offer them food when they’re most awake and well-rested. You might try to have them rest for 30 minutes right before eating.
  • Make sure they’re sitting as upright as possible.
  • Give them plenty of time to eat. Remind them to eat slowly and to take small bites and sips.
  • Keep mealtime as peaceful as possible. Eating with distractions like loud noises or TV can make them more likely to choke.
  • Offer them smaller meals throughout the day.
  • Offer them a sip of drink after each bite of food.
  • Stay close by as they eat.
  • Remind them to swallow, and make sure their mouth is empty before they take another bite.
  • Change the foods you offer, or the way you prepare food or drinks. For example, use thickeners in fluids like water or juice: sometimes fluids that are milkshake-like go down the throat more smoothly.
  • Offer them soft foods like finely blended meats and vegetables with smooth sauces, strained soups, puddings, soufflés, and yogurt.
  • Try moistened ground meats and breads, cooked or canned fruits and vegetables, and thickened cereals.
  • Cut food into small pieces.
  • Avoid foods that are sticky, like peanut butter, or very hot or cold.
  • Use a sippy cup.
  • Help them clean their teeth.
  • Take them to the dentist regularly. Painful or missing teeth or dentures that don’t fit well can make it hard to chew. They also make your loved one more likely to choke.
  • Try not to give your loved one medicines that can make them feel sleepy or have a dry mouth.

You also might talk with their doctor about having them work with a speech therapist to strengthen the muscles used in swallowing and recommend tips and guidance.

To keep both yourself and your loved one safe during meals, don’t put your fingers in their mouth while you feed them, while you clean their teeth, or if they’re choking. If they get agitated or upset at meals, use plastic or dull utensils.